WebFrm MC-5876 M o iration Date 3 /31/202 Medical Examiner’s Certificate (for Commercial Driver Medical Certification) Public Burden Statement. A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of … WebCertification of Physical Exemption 49 CFR PART 391/390 CDL-10 These forms allow you to certify to one of the CDL categories listed below, which determines if a medical variance or a U.S. Department of Transportation (DOT) Medical Examiner's Certificate is required to be on file with the Department.
FORMS/ Services - DOTphysicalCT
WebJan 30, 2012 · The self-certification requirement goes into effect on January 30, 2012. Applies to drivers applying for, renewing, upgrading or replacing a commercial driver’s license, class A, B or C. As a commercial driver, if there is a change in your medical status or interstate/intrastate status, you must provide DVS with a new self-certification form ... WebAug 31, 2024 · Medical Certification Forms MCSA-5875 & MCSA-5876 New expiration date on the forms is 12/31/2024. PDF Versions of the forms are available at these links on the FMCSA website: Medical Examination Report (MER) Form, MCSA-5875 Medical Examiner’s Certificate (MEC), Form MCSA-5876 green buttercup squash
21 Dot Physical Forms 2024 - Free to Edit, Download & Print
Web• Visit www.dmv.pa.gov and Enter Search Term "Pub-195NC," and review required documents; or • Contact us at 717-412-5300. TTY callers - please dial 711 to reach us. All documents must show the same name and date of birth, or an association between the information on the documents. WebDec 6, 2015 · Form MCSA-5876 (Revised: 12/06/2015) OMB No. 2126-0006. Expiration Date: 8/31/2024. Medical Examiner's Certificate ... The information I have provided regarding this physical examination is true and complete. A complete Medical Examination Report Form, MCSA-5875, with any attachments embodies my findings completely and … WebThe information I have provided regarding the physical examination is true and complete. A complete Medical Examination Report Form, MCSA-5875, with any attachment, contains … green butterfly clip art